Motor skills or coordination is the product of a complex set of cognitive and
physical processes. Smooth, targeted, and accurate movements, both gross and
fine, require the harmonious functioning of sensory input, central processing of
the information in the brain and coordination with the high executive cerebral
functions, such as volition, motivation, motor planning of an activity. The
performance of a certain motor pattern is also important. All of these elements
must work in a coordinated and rapid way to enable complex movements involving
different parts of the body.

Motor Skill

Gross Motor Skills

Includes lifting one's head, rolling over, sitting up,
balancing, crawling, and walking. Gross motor development usually follows a
pattern. Generally large muscles develop before smaller ones, thus, gross motor
development is the foundation for developing skills in other areas like fine
motor skills. Development generally moves from the top of the body down to the
bottom.

Fine Motor Skills

Includes the ability to manipulate small objects, transfer
objects from hand to hand, and various hand-eye coordination tasks. Fine motor
skills may involve the use of very precise motor movement in order to achieve an
especially delicate task, for example, the pincer grasp using the thumb and
forefinger to pick up small objects, cutting, coloring, or writing. Fine motor
development refers to the development of skills involving the smaller muscle groups.

Ambidexterity

Is a specialized skill in which there is no dominance between body
symmetries, so tasks requiring fine motor skills can be performed with the left
or right extremities. The most common example of ambidexterity is the ability to
write with the left or right hand, rather than one dominant side.

Motor skill dysfunction has many causes, such as the demyelination of motor
neurons. While fatigue or weariness may lead to temporary short-term
deterioration of fine motor skills observed as visible shaking, serious nervous
disorders may result in a loss of both gross and fine motor skills due to the
hampering of muscular control.

Motor Symptoms

Motor symptoms have to deal with the muscular movement of any part of the
body. This movement refers to something that produces or refers to motion. An
example being a motor neuron is a nerve cell that conveys an impulse to a muscle
causing it to contract. Multiple sclerosis (MS) motor symptoms typically involve weakness, leg
dragging, stiffness, a tendency to drop things, a feeling of heaviness,
clumsiness, or a lack of coordination. It's associated with muscle tightness and
weakness that limit a limb's range of movements.

Muscle-related symptoms most often occur in the arms and legs and at times,
these symptoms may impair walking. Spasticity, which is the involuntary
tightening of a muscle, can manifest as stiffness, pain or spasms. Some may
experience an intention tremor causing difficulty in making small or complex
movements and notice their hands shake when trying to pick something up, write,
or button their shirt.

Muscle-Related Symptoms may include:

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Loss of balance

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Numbness or abnormal sensation in any area

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Pain because of muscle spasms

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Pain in the arms or legs

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Problems moving arms or legs

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Problems walking

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Problems with coordination and making small movements

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Slurred or difficult-to-understand speech

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Tremor in one or more arms or legs

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Uncontrollable spasm of muscle groups (muscle spasticity)

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Weakness in one or more arms or legs

Spasticity

A cramp is a sudden, brief, unintended (involuntary),
and usually painful contraction of a muscle or group of muscles.

Muscle cramps (also called charley horses) often occur in healthy people, usually in
middle-aged and older people but sometimes in younger people. Cramps tend to occur
during or after vigorous exercise but sometimes occur during rest. Some people have
leg cramps during sleep and usually affect the calf and foot muscles, causing the
foot and toes to curl downward. Although painful, these cramps are usually not
serious and are thus called benign leg cramps.

Having tight calf muscles is a common cause of leg cramps. Muscles become tight when
they are not stretched, when people are inactive, or sometimes when fluid repeatedly
accumulates (called edema) in the lower leg.

Low levels of electrolytes (such as potassium, magnesium, or calcium) in the blood
can also cause cramps. Low electrolyte levels may result from use of some diuretics,
alcoholism, certain endocrine disorders, vitamin D deficiency, or conditions that
cause loss of fluids (and thus electrolytes).

Spasticity is a condition in which certain muscles are
continuously contracted. This contraction causes spasms, stiffness or tightness of
the muscles and may interfere with movement, speech, and manner of walking. Spasticity
is usually caused by damage to the portion of the brain or spinal cord that controls
voluntary movement.

You might feel spasticity either as stiffness that doesn’t go away or as movements
you can’t control that come and go, especially at night. Spasticity also can make
you ache or feel tight in and around your joints and low back. How you feel can
vary depending on your position, posture, and how relaxed you are.

Symptoms may include hypertonicity (increased muscle tone), clonus (a series of
rapid muscle contractions), exaggerated deep tendon reflexes, muscle spasms,
scissoring (involuntary crossing of the legs), and fixed joints. The degree of
spasticity varies from mild muscle stiffness to severe, painful, and uncontrollable
muscle spasms. Spasticity can interfere with rehabilitation in patients with certain
disorders, and often interferes with daily activities.

Almost everyone with MS will have some loss of mobility, which may take the form
of impaired (lessened) motor control, muscle weakness, impaired balance, and
spasticity. Spasticity is one of the primary symptoms of MS and is characterized
by weakness, loss of dexterity, and the inability to control specific movements.
It's usually more severe in the legs and torso. Mobility can also be affected by
many non-physical factors including mental well-being, social networks, fatigue,
and even the weather.

The Cause

Spasticity occurs as a result of an imbalance between the excitatory and
inhibitory signals from the brain and/or spinal cord. Excitatory signals send
messages to other neurons, firing them into action, whereas inhibitory signals
stop neurons firing and suppress a response, such as stopping a full bladder
from spontaneously emptying itself. It's thought that there is an interruption
of the inhibitory signals along the spinal cord and in the brain which results
in an increased excitation and therefore an imbalance.

Spasticity can be complicated by dystonia where the problem is not only increased
muscle tone but odd postures such as neck twisting to one side or the other. Dystonia
can also exist alone as an isolated movement disorder in MS. One or more muscles or
muscle groups can be involved in spasticity or dystonia. Muscle spasticity, or
excessive tightness, is common and may be more disabling than weakness.

It can get worse when it's too hot or cold, when you have an infection, or if you're
wearing tight clothing. It can also be present at any point of the disease (early or
late onset) and the symptoms can vary from mild to severe. In severe cases, spasticity
can even cause a limb to become "frozen" in a bent position, requiring immediate
medical attention.

It's important that the person with spasticity is positioned correctly when
sitting and lying down to prevent limbs becoming fixed in an inappropriate
position. They should be able to lie flat every day in order to stretch the
muscles involved. Lying on the side and standing are also useful for stretching
muscles in spasm. Posture when sitting needs to be well balanced and stable.
Special seating systems are available to help with this. The person should be
moved regularly to avoid damage to skin and help in joint mobility. Design of
the wheelchair is also important, as it's essential that it provides support for
the upper body and limbs.

Spasticity affects body functions and can cause activity limitations and participation
restrictions, primarily due to its effect on functional movement.

Detrimental Consequences Associated with Spasticity:

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Interference with mobility, ability to exercise and the range of motion in joints

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Negative impact on endurance and energy expenditure

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Interference with the activities of daily living

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Discomfort or pain

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Sleep disturbance

Treating MS Spasticity

Physical therapy, medications, surgery, or a mix of these treatments can ease
spasticity when you have MS. To decide the best way to help you, your doctors
will think about your overall health, how severe your symptoms are. Other
considerations that need to be looked at range from pain level, cost, side
effects, and so on.

Physical and Occupational Therapy
Most of the time, a physical therapist can treat MS spasticity with a basic
physical therapy stretching program. The goal is to lengthen your muscles which
should ease the condition. An occupational therapist may recommend different tools,
like splints, casts, or braces, to keep up your range of motion and flexibility.
If physical and occupational therapy don’t help, your doctor may want to try medications.

Medications
The most common medications to treat the condition include the muscle relaxants
baclofen (Gablofen, Kemstro, Lioresal) and tizanidine (Zanaflex). Another option
is diazepam (Valium), which can help you sleep if nighttime spasms keep you awake.
If pills don’t work, your doctor might be able to put a pump inside your body to
deliver the medication directly to your spinal fluid like with a baclofen pump.
You can also get shots of botulinum toxin (such as Botox or Myobloc) to relax
your muscles.

Surgery
When other treatments don't work, there are two types of surgery that can treat
spasticity:

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Rhizotomy is where a surgeon cuts away part of the spinal nerve.
The goal is to relieve pain or ease muscle tension.

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Tenotomy is where a surgeon cuts severely tight tendons away from
the muscles. It may make spasticity happen less often and make it
less severe, depending on how old you are. Over time, you may need
to have the surgery again.

These surgeries can help, but they’re usually only for extreme cases of spasticity
and are rarely performed in patients with MS.

It's important to approach spasticity management from an interdisciplinary team
approach with everyone involved so they can better identify goals and make the
adjustments necessary to attain optimal spasticity management. Goals of
spasticity management should be orientated towards the improvement of function
and improved comfort, and an individual's response to interventions such as
medications, rehabilitation or surgery needs to be closely monitored.